Objectives
For patients with acute myeloid leukemia in first complete remission (AML CR1) lacking HLA‐matched sibling donors (MSD), 8/8‐matched unrelated donors (URD) are mostly used in cases with poor‐risk features. For AML CR1 with intermediate cytogenetics, however, the benefit of 8/8‐matched URD should be compared with non‐allogeneic therapies as well as MSD.
Methods
To address this issue, we assessed the transplantation outcomes of 8/8‐matched URD (n = 54) compared with MSD (n = 145) or autologous transplantation (n = 89) for AML CR1 with intermediate cytogenetics.
Results
In multivariate analyses, 8/8‐matched URD had comparable 6‐yr overall survival (OS, P = 0.997), disease‐free survival (DFS, P = 0.951), and relapse (P = 0.672) to MSD, whereas 8/8‐matched URD had a higher OS (P = 0.070) and DFS (P = 0.035) with lower relapse (P = 0.009) than autologous transplantation. No difference in non‐relapse mortality was observed according to donor type. Notably, these equivalent or superior outcomes of 8/8‐matched URD compared with MSD or autologous transplantation, respectively, were particularly evident in patients without poor‐risk features (n = 200), such as older age, hyperleukocytosis at diagnosis, and myelodysplasia‐related changes, who are not usual candidates for URD transplantation.
Conclusions
These results indicate that 8/8‐matched URD are feasible next option in AML CR1 with intermediate cytogenetics, when lacking MSD, even in patients without poor‐risk features.